KS Preceding Immune Suppression

KS PRECEDING IMMUNE SUPPRESSION
In the early AIDS epidemic, Kaposi's Sarcoma was one of the
the key indicators in making the diagnosis of "AIDS".
An unexplained peculiarity was that Kaposi's Sarcoma
affected primarily gay men, by an overwhelming margin.
KS was virtually unknown in cases of transfusion AIDS, a
very odd fact considering that blood was one of the primary
ways of transmitting HIV.
There was a strongly alleged connection to poppers used
by gay men. More recently researchers have claimed that
a herpes-type virus appears to have caused KS.
Why would a new herpesvirus have appeared at the same time
as HIV, nearly simultaneously? The answer given by some
researchers was the the KS virus was *not* new. It is
postulated to have been already widely spread, but simply
manifested itself more often as KS in immune-suppressed
patients.
That is the type of "brush-off" explanation that the gay
community has accepted too uncritically and too complacently.
There are reasons to doubt that story.
Last week, I came across a 1992 study by Robert Gallo, et al.
One of his discoveries was that KS *frequently* preceded any
sign of immune suppression [1].
That finding blows out the water the comforting notion that
immune suppression would be key factor giving expression
to KS.
Of course, there are other problems with the herpesvirus
theory. There is also the problem of KS appearing in
HIV negative men [2].
There is also the problem of why KS declined so steeply among new
AIDS patients, in the 1980s. Among 1,341 men with AIDS, the
proportion showing Kaposi's sarcoma declined from 79% in 1981
to 25% in 1989. [3].
Why would the prevalence of a herpes virus decline so
suddenly and dramatically, among sexually active people who
were getting exposed to HIV? What steeply declined in this
time period was the used of poppers, which were strongly
alleged to have a causative role in KS.
There is also the question of why a herpes-based virus should
not be widely prevalent in sexually promiscuous heterosexuals
as well, given the extremely widespread nature of other types
of herpes virus.
The facts that KS appeared in HIV-negative gay men, and in
gay men lacking any immune suppression, suggests that the
cause, whatever it may have been, was *inherently* dangerous
and causative of KS, on its own.
Why then would poppers, in use for decades, not have shown previous
KS cases? Why would a supposedly wide-spread herpes virus
not have shown previous KS cases?
The devil is in the details. Some of the interesting details are
buried in obscure studies that sit in databases, their implications
never realized by our too-complacent community.
We would be prudent to be a little more paranoid and
insist on real answers to these puzzles and mysteries.
What really happened to us?
Tom Keske
Boston, Mass.
REFERENCES
[1] J Immunol 1992 Dec 1;149(11):3727-34
Effects of cytokines from activated immune cells on vascular
cell growth and HIV-1 gene expression. Implications for AIDS-
Kaposi's sarcoma pathogenesis.
Barillari G, Buonaguro L, Fiorelli V, Hoffman J, Michaels F,
Gallo RC, Ensoli B
Laboratory of Tumor Cell Biology, National Cancer Institute,
National Institutes of Health, Bethesda, MD 20892.
Kaposi's sarcoma (KS) arises more frequently in homosexual and
bisexual men than in other groups of HIV-1 infected individuals.
Clinico-epidemiologic data indicate that homosexuals often are
infected with multiple microbial agents and/or subjected to
other antigenic stimuli, preceding or accompanying HIV-1
infection. Signs of immune activation, in fact, frequently have
been detected in these individuals, and the onset of KS can
precede any sign of immunodeficiency.
[2] http://www.aegis.com/pubs/aidsline/1992/dec/M92C5381.html
Lancet; 335(8682):168-9 1990. Unique Identifier : AIDSLINE
ICDB/ 92688101 Friedman-Kien AE; Saltzman BR; Cao Y; Nestor MS;
Mirabile M; Li JJ; Peterman TA; Dept. of Microbiology, New
York Univ. Medical Center, New York,; NY 10016
Abstract: Kaposi's sarcoma (KS) was rarely seen in the United
States before 1980. An aggressive type of KS has become
widespread during the HIV/AIDS epidemic, mainly affecting
homosexual men. 349 homosexual or bisexual men with biopsy
proven KS seen in a university hospital-based dermatology
practice between 1981 and 1989 were tested for antibodies to
HIV-1, and 6 were HIV-1 negative. Case histories and
laboratory data for the HIV-1 negative patients (pts) are
presented.
[3] Am J Epidemiol 1990 Feb;131(2):221-31
Kaposi's sarcoma in a cohort of homosexual and bisexual men.
Epidemiology and analysis for cofactors.
Lifson AR, Darrow WW, Hessol NA, O'Malley PM, Barnhart JL, Jaffe
HW, Rutherford GW